The management of adults who have severe growth hormone deficiency (GHD) includes its recognition in susceptible patients, including all subjects who have any form of hypothalamic pituitary disorder. This article also focuses on the overall management of adults who have hypopituitarism and severe GHD. This includes aspects of diagnosis and management of growth hormone replacement therapy and the current status of its long-term safety. Some special circumstances, including the pregnant woman who has hypopituitarism, are discussed.